MRI-confirmed Lumbar Herniated Discs: 88% Still Improved 1 Year After Chiropractic
Patients & Friends,
Of 148 patients with Magnetic Resonance Imaging-confirmed lumbar herniated discs, 88% were still improved one year after chiropractic, in a study reported in the March/April 2014 issue of the Journal of Manipulative and Physiological Therapeutics.
Consecutive patients presenting to a group chiropractic practice in Zurich, Switzerland, all had back pain and moderate to severe leg pain and at least one neurologic or disk sign, as well as MRI confirmation of a herniated disc.
Patients in acute pain (n = 80) of less than 4 weeks onset saw their pain scores drop on average from 6.2 to 2.6 within the first two weeks of chiropractic care, and at 1 year follow up their improvement continued with average pain scores of only 1.2.
Even another group of patients with chronic back and leg pain (n = 37) saw their average pain drop from 5.8 to 3.7 in just two weeks, and as with acute disc patients improvement was maintained at all data collection points (2 weeks, 1 month, 3 months, 6 months and 1 year) with pain after 1 year averaging only 2.0.
In contrast with improvement (patient self-rated pain as "better" or "much better") 1 year later in 86.3% of acute disc patients and in 89.2% of chronic disc patients, only 3.8% of acute disc patients were worse, and only 2.7% of chronic disc patients were worse after a trial of chiropractic care. Only four patients dropped out, 3 proceeded to surgery, and one received epidural injections, while 15 were lost to follow up. No adverse reactions to chiropractic were reported by patients during the blinded follow up by a hospital based research team.
The researchers explained that normally 36% of patients with sciatica see major improvement at 2 weeks and 73% have resolution of leg pain within 12 weeks, and that chiropractor treated patients in this study saw much faster improvement in acute sciatica than one might expect from natural history.
Similarly, the fact that patients with chronic back and leg pain (symptoms lasting over 450 days average prior to chiropractic) also saw nearly as dramatic improvement, suggests that chiropractic had clinically meaningful effects in this group of patients.
The study adds to the growing evidence basis for a trial of chiropractic care when patients present with MRI-confirmed lumbar herniated disc related back and leg pain.
Robert A. Leach, DC, MS, FICC(h), CHES
1. Chiropractic researchers at the Chiropractic Medicine Department at the University of Zurich did blinded interviews to determine progress in consecutive cases of MRI-confirmed acute and chronic lumbar disc herniation and found significant improvement for all outcomes at all time points ( P<.0001), that was faster than what would be expected from natural history: http://www.ncbi.nlm.nih.gov/pubmed/24636109
2. 102 patients with MRI-confirmed lumbar disk herniation had as much relief after chiropractic as after imaging-guided lumbar nerve root injections in this trial from the same Orthopedic University Hospital in Balgrist, Zurich: http://www.ncbi.nlm.nih.gov/pubmed/23706678
3. After referral from primary care physicians to neurosurgeons, of 120 screened 40 consecutive patients that met criteria (failed at least 3 months of nonoperative management including treatment with analgesics, lifestyle modification, physiotherapy , massage therapy and/or acupuncture) were randomized to chiropractic or surgical microdiskectomy, with crossover allowed after 3 months. Fully 60% of sciatica patients that failed physiotherapy and other treatment responded as well to chiropractic as to surgery, and 3 cases that crossed over when chiropractic did not help saw good improvement with surgery. This offers empirical evidence that a trial of conservative care prior to surgery should include chiropractic: http://www.ncbi.nlm.nih.gov/pubmed/21036279
4. In this prospective observational cohort study 49 patients received chiropractic and physical therapy for lumbar disk herniation; patients initially reported "good" or "excellent" results in almost 90% of cases after an average of 13.2 visits, and after 14.5 months of follow up "good" or "excellent" improvement continued in 80% of cases was observed, with clinically meaningful improvement in disability maintained by 73% of patients: http://www.ncbi.nlm.nih.gov/pubmed/20004799
5. With the exception of true emergencies such as cauda equine syndrome (pain in both legs, loss of bowel or bladder function, numbness in the buttock), patients with lumbar disk herniation should consider a trial of chiropractic prior to surgery based on both effectiveness and less risk: http://www.ncbi.nlm.nih.gov/pubmed/20359960